“No Care For You!”

Elaine has been a large part of my life for a few decades now, along with Jerry, Kramer and George. Having Seinfield always playing in the background gave me an appreciation for differing characters and the art of the one-liner. Julia Louis-Dreyfus’s roles since Seinfeld have been equally entertaining, as evidenced by her 6 Emmy’s for Veep. When I heard about her diagnosis of breast cancer, I was sad for a number of reasons; not only because I have close friends my age that have recently gotten the same devastating news, but also because I know life won’t be the same for her and she will now be someone who will always have to qualify her pre-existing condition. But the reason I’m writing about someone I don’t even remotely know is not because of her Hollywood accolades, but because of how she handled this diagnosis. 

Seeing someone with this much influence use her platform for a call for change was inspiring stating “the bad news is that not all women are so lucky, so let’s fight all cancers and make universal health care a reality”, and I couldn’t agree more. Note the classic Seinfield timing – she said this just one day after the Graham-Cassidy bill (not shockingly) failed to gain enough votes to pass. I would be lying if I didn’t find some joy seeing Mitch McConnell fail time and time again, however, it is no longer comical how incapable we are as a nation to get a critical bill to pass.

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Update in the healthcare saga: Sips wine, breathes deep. With this most recent bill failing to get necessary support, Trump has made known that he plans to use an executive order to force a change to Obamacare this week. Making this announcement on World Mental Health Day was ironic and alarming for those with mental health conditions, because they are another population that is vulnerable to premium hikes or losing coverage of essential benefits for care.

Using an executive order, Trump plans to enact health care changes – namely opening up association healthcare plans to small businesses and individuals, which allow them to combine with other businesses or groups, across state lines, to purchase health care plans rumored to be exempt from the mandates outlined in the Affordable Care Act. Some of those mandates include eliminating lifetime limits, same cost coverage for pre-existing conditions, and the offering of 10 essential benefits. This would now give ‘healthy’ individuals the option to obtain limited benefits and pay lower premiums under the same insurance plan, which does not sound all that bad, except those people who aren’t ‘healthy’ will then be excluded from those insurance options and will be given options that cost triple what we currently pay.

Don’t get me wrong, I also see the need for change to Obamacare and see the frustration Trump experiences with the inability to pass a bill, however, our legal system wasn’t developed in such a way to circumvent lawmaking when you don’t get your way. I see the benefit to increased competition and having the option for cheaper plans for individuals who are young and healthy and who don’t need to carry the type of insurance I have, however, what will most likely end up happening is that prices will get driven up for those like me, as well as the terminally ill, the elderly, etc. and insurers will come to me offering those bare bones benefits, requiring me to pay more for those services I need, something that those in West Virginia will experience next year due in part to the state government’s refusal to pay insurer subsidies.

Note: Executive Orders have the same force of law as regulations. They can be overturned by judicial review or by Congress. Congress can overturn if acting under authority granted by Congress, which President can then veto, but Congress can come back and override the veto with two-thirds majority vote. Conversely, a Bill is a much more time intensive process that requires majority approval of both the House and the Senate before being signed by the President. A process which was designated to vet issues like this to their fullest potential.

Why Am I Still Rambling?

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Just prior to my Denver trip, I got a couple-thousand dollar bill for my Entyvio treatments, because the infusion center hadn’t properly registered assistance offered by the pharmaceutical company to pick up the tab for the rest of my treatment. Panic sets in. Keeping track of these bills and statements while trying to work full time, enjoy some parts of life and manage Crohn’s Disease is really difficult. Even debilitating at times, and produces anxiety and fear in me. Can I pay these bills? What did I miss in the fine print? I’m an attorney, I should know better. Will I ever be able to save? Can I start working more again soon? Life gets sidelined and completely derailed by medical bills, the cost for which will just continue to skyrocket and take more from my pockets if these changes are made. What if it was you? What would you do?

After looking at my EOB, I then found out each treatment prior to insurance applying costs $9,785.02. If anyone wants to do the math, that means Entyvio alone has cost just shy of $40,000 so far (still have one treatment left this year) and my colonoscopy was another $11,460.45 – meaning I have received over $50,000 in treatment in 6 months, without accounting for prescriptions. Overall, I have had to pay about $200 for this. This will NOT be the case if insurers get to pick and choose what benefits they will offer me at what price point. I can say goodbye to a large portion of my salary or opt to not receive treatment.d2763b1e-8c61-4437-be04-f3976ada7d7f

With all of these changes, there comes competition. Pfizer, the pharmaceutical company, is taking a hard look at divesting their consumer healthcare business, while Amazon has announced the possibility of establishing their own prescription drug distribution service. For now… Yada, Yada, Yada, you know the rest.


5 thoughts on ““No Care For You!”

  1. I love Seinfeld and feel for Julia Louis-Dreyfus going through this battle. I also love how she used it for good. Our government is in such a bad place. It so often seems they are so busy fighting for what “they” want that we the citizens get pushed aside. I don’t really like what Trump did pushing through-but he really is putting pressure on others to get something done. Unfortunately I think it is needed. Something has to be done. I am at high risk for cancer and the tests to scan for cancer are so high now that it makes me consider not getting them. But, the cost of cancer is much higher. Raising my wine glass..here’s to hoping some positive steps are made in health care! Thanks!

    1. I agree. It’s good that we are having the conversation, it’s just alarming our needs aren’t prioritized more. I hate that we have to decide whether a test is worth it financially. Thanks for reading! I know it’s not a light topic, and is a scary one for many of us. Cheers, Toni!

  2. Sniffled is a classic, love it! I’m so sorry you have to go through this. The healthcare industry is so frustrating! I hope you find time to breathe and take the time you need for self-care to help with your anxiety and fear. Thank you for sharing this!

    1. Thanks Lori! I try! I think the more we educate ourselves on the topic the more we can understand and interpret these changes and communicate to our representatives the need to prioritize our care and it’s associated costs. *takes deep breathe* 🙂

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